Stepwise Surgical Treatment for Severe Elbow Contracture After Trans-olecranon Fracture-Dislocation: A Case Report.

Posttraumatic elbow contracture following trans-olecranon fracture-dislocation presents a complex challenge due to extensive soft tissue damage and joint stiffness. We report a case of a 46-year-old man who developed severe elbow contracture after the open reduction and internal fixation of a trans-olecranon fracture-dislocation, with a flexion-extension arc limited to 40° and forearm rotation restricted to 50°. A stepwise, three-phased surgical approach was employed. The first stage consisted of arthroscopic capsular release to address flexion-extension contracture. The second stage involved the open debridement of the proximal radioulnar joint and radial head replacement for rotational limitation. The third stage consisted of a repeat arthroscopic release to treat the residual restriction of flexion. Each procedure was tailored to address distinct mechanical contributors to the multifactorial stiffness, aiming to restore motion and alleviate pain through gradual functional recovery. At final follow-up, the patient achieved a flexion-extension arc of 125° and forearm rotation arc of 150°, with full return to pain-free daily activity. This case highlights the importance of staged intervention in managing complex elbow stiffness and suggests that individualized surgical sequencing can lead to favorable outcomes even in severe posttraumatic cases.